Alcohol is the third leading contributor to death and disability in South Africa, where SABMiller is the major supplier of malt beer, the most popular beverage consumed. The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) has recently included SABMiller as a recipient of funding for an education intervention aimed at minimizing alcohol-related harm, including HIV prevention, among men in drinking establishments. Global Fund support for this initiative is cause for concern, according to the authors of this article. They argue that it is debatable whether these men are the best target group for the intervention, whether a drinking establishment is the best location, and whether the educational intervention itself is effective. The authors argue that the industry supports interventions that will not affect drinking rates at a population level. These interventions allow the industry to fulfil social and legal obligations to address the harmful use of alcohol while ensuring that sales and profits are maintained. Providing funding for an industry that could afford to fund its own interventions also reduces the funds available for less well-resourced organisations.
Public-Private Mix
Business is being urged to use its resources and expertise in partnership with the public sector to improve sub-Saharan Africa’s weak healthcare systems in a White Paper, From Funding to Action: Strengthening Healthcare Systems in Sub-Saharan Africa, launched today by the Global Health Initiative at the World Economic Forum on Africa in Cape Town.
In recent years, tax-exempt private foundations and for-profit corporations have increasingly engaged in relationships that can influence global health. Using a case study of five of the largest private global health foundations, the authors of this study identified the scope of relationships between tax-exempt foundations and for-profit corporations. They found that many public health foundations have associations with private food and pharmaceutical corporations. In some instances, these corporations directly benefit from foundation grants, and foundations in turn are invested in the corporations to which they award these grants. Personnel move between food and drug industries and public health foundations. Foundation board members and decision-makers also sit on the boards of some for-profit corporations benefitting from their grants. While private foundations adopt standard disclosure protocols for employees to mitigate potential conflicts of interests, these do not always apply to the overall endowment investments of the foundations or to board membership appointments. Transparency or grant-making recusal of employees alone may not be preventing potential conflicts of interests between global health programmes and their financing, the authors conclude.
The private health sector in the developing world is poorly understood, best practices are not documented, promising initiatives are not scaled for broader application, and there is mistrust between the public and private sectors. Yet all acknowledge a comprehensive approach to the critical health worker shortage must involve the private sector. The private health sector in resource-poor settings relies on an enabling environment of civil society, financial and operational resources. How that interrelationship between society and the private sector operates and potentiates greater scaling of innovative responses to the HRH crisis is not understood. Scaling and implementation of innovative private sector responses will require greater understanding of this relationship. The Alliance has agreed to support the development of a Task Force on private sector involvement in human resources for health to ensure that identified innovative private sector models will gain broader attention and implementation and scaling up of these models into other locales can be facilitated. The overarching goal is to accelerate the scaling and cross-border movement of initiatives in the private health sector, which can increase the supply of new workers, improve the efficiency and effectiveness of existing health workers and reduce the attrition of health workers out of the field of practice or movement out of region.
This brief examines the policy implications of increased activity between the UN and the corporate sector, specifically focusing on the increased collaboration between the corporate sector and the World Health Organization (WHO), UNICEF and UNFPA. The brief also explores the major global health-related public-private partnerships (GHPPPs) which operate primarily outside the UN, such as the Global Alliance for Vaccination and Immunisation (GAVI). The brief concludes that, although guidelines and procedures to address public-private interactions (PPIs) have been developed within UN agencies, they are inadequate to ensure UN integrity.
In this article, the author presents global data on access to pharmaceuticals and discusses underlying barriers. Two are highly visible - pricing policies and intellectual property rights – while two are less recognised - the regulatory environment and scientific and technological capacities. Two ongoing transitions influence and even distort the problem of universal access to medications, the author argues, namely the epidemiologic transition to an increasing burden of chronic non-communicable diseases, and the growing role of biotechnology products (especially immunobiologicals) in the pharmacopeia. Examples from Cuba and Brazil are used to explore what can and should be done to address commercial, regulatory, and technological aspects of assuring universal access to medications.
Global Public Goods for Health addresses the growing globalization of health from the unique perspective of the economic concept of public goods. This concept identifies where a ‘good’ or service (such as knowledge of an infectious disease outbreak) which would be of benefit globally will not be produced or disseminated if left to ‘the market’, because of a lack of incentive: no-one can be excluded from accessing the good, no charge can be levied for use and no costs recouped.
The authors of this paper reviewed and synthesised findings from eight independent evaluations of Global Health Partnerships (GHPs) as well as research projects they had conducted themselves. They present the major drivers of the current GHP trend, briefly review the significant contributions of GHPs to global health and set out common findings from evaluations of these global health governance instruments. The paper answers the question of how to improve GHP performance with reference to a series of lessons emerging from the past ten years of experience. These lessons cover the following areas: value-added and niche orientation; adequate resourcing of secretariats; management practices; governance practices; ensuring divergent interests are met; systems strengthening; and continuous self-improvement. The authors argue in favour of sustained critical reflection and independent evaluation of GHPs so as to ensure optimal results, given the high level of resources that collaboration demands. They call for the opening up of spaces for public debate so that the findings from evaluation can be frankly discussed, as well as highlight the need to apply lessons more widely across and within partnerships.
Global public-private health partnerships, as a means of global health
governance, have become increasingly common. Initially, much was
expected of them but enthusiasm has now waned, with concern raised over
costs and unanticipated consequences. What bad habits impact negatively
on their performance and what actions could make them more effective?
To attract greater levels of foreign direct investment into their gold mining sectors, the authors observe that many mineral-rich countries in sub-Saharan Africa have been willing to overlook serious instances of mining company non-compliance with environmental standards, and that these lapses in regulatory oversight and enforcement have led to high levels of pollution in many mining communities. This is argued to raise the risk of pollution-related sicknesses, such as skin infections, upper and lower respiratory disorders, and cardiovascular diseases, will necessitate increasingly high healthcare expenditures in affected communities. In this study, the authors propose and estimate a model that relates healthcare expenditure to the degree of residents’ exposure to mining pollution using data obtained on gold mining in Ghana. The empirical results confirm that, after controlling for factors such as current and long-term health status, increased mining pollution leads to higher healthcare expenditure.